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De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quarta-feira, 1 de junho de 2005 09:37
[ProCOR] Conference report: 6th ICPC "Protecting the heart ofglobal development"
The 6th International Conference on Preventive Cardiology convened more than 700 international participants to discuss how clinical practice, community intervention, and policy development can promote global heart health. At those who attended head home, we must ask ourselves:
What did we learn? What next steps will we take? What concrete actions will result? What will have changed in four years, at the next conference? We invite all of our global colleagues to utilize ProCOR as a forum in which to continue and expand the conference, and to discuss these important questions.
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Only half of the world's countries have surveillance systems. "We can't guide the development of policy, and we can't make wise decisions about the allocation of scarce health resources, unless we track trends in health status," said Ruth Bonita, WHO. "Using this information, we can develop appropriate and effective interventions and evaluate them." WHO's STEPwise approach assists countries in collecting information about NCD risk factors in their unique settings (www.who.int/chp/steps> or email rileyl@who.int)
Surveillance data paves the way for policy development. Less than 50% of countries have a national NCD policy; less than 30% have a CVD plan, and less than 40% have a tobacco plan. Surveillance data can be incorporated into successful strategies that place heart health on the political agenda. Sylvie Stachenko, Canada, reminded attendees that "we need to communicate with policy makers in plain language that helps them understand the urgency. Tell them the stories. Use reports and important documents. Engage the media in publicizing the problem. Link the heart health agenda to other policy agendas. Make the economic case--show how policies will translate to reduced burden on health care.But always insist that economics are not more important than health." Dr. Stachenko emphasized the roles of government, the private sector, industry, NGOs, and civil society advocates. "By educating the public, we can build consumer demand, which in turn can drive policy development. Health ministries need to take a stewardship role in rallying other players, but a heart-healthy society is a shared effort."
While policy creates environmental change, successful population approaches are delivered in partnership with communities. Working with communities requires knowing and valuing their cultures, contexts, and dynamics. Multi-factoral approaches work better than single approaches; a program addressing physical activity and nutrition will produce more benefit than a physical activity program alone. Engaging a range of sites--home, workplace, schools--further increases change.
Brian O'Connor, Canada, outlined strategies for population-based programs, including community mobilization and education, social marketing and media, health promotion programs, alliances and partnerships, and involvement of the community in policy making. Examples of interventions from the world can be reviewed online at www.internationalhearthealth.org. The social determinants of health--risk conditions in which people live--are an important component of community health programming. Dr. O'Connor pointed out that "many of the tools we develop are sophisticated and can't reach people living on the margin.
Approaches should be tailored to take this into consideration.
Partnerships with communities produce benefits beyond improved health status.Communities that participate in planning develop a sense of ownership that increases the likelihood of success and sustainability. Leadership and other community capacity such as advocacy and planning skills can be transferred to
other areas and contribute to a healthier environment. But building an infrastructure requires a sustained and committed effort and willingness to share control of the agenda. "The community is not a laboratory," Dr. O'Connor warned. "Don't take the data and depart. Don't patronize them. Engage them in the process."
Darwin Labarthe, USA, examined the role of physicians and the choices that they face: "Rescue the individual, report accumulated cases, or respond to community needs. All are essential." Physicians can influence health on many levels--by promoting health for all, encouraging healthy lifestyles for their patients, identifying and treating underlying conditions, diagnosing and treating CVD, preventing occurrences, and enhancing quality of life for those with CVD."
This shift in the physician's role calls for a redefinition of primary care, noted David MacLean, Canada. "Primary care is multidisciplinary and assumes an active role in chronic disease prevention. Physicians can enhance preventive practice by utilizing multiple approaches." Noting that for many physicians "their idea of preventive medicine is vaccination," Dr. MacLean described a Russian polyclinic where doctors with minimal resources nevertheless were able to successfully manage their patients' CVD risk.
It is encouraging that this international conference on preventive cardiology addressed issues that extended far beyond the physician's examination room or the hospital's catheterization lab.
But questions remain. What have we learned during these days of discussions?What next steps will each of us take to translate what we learned into action? In four years, at the next conference, what will have changed?
Aloyzio Achutti, Brazil, reminded participants that "Our scientific meetings must be permanent. It is important for us to stay connected through a virtual community. The technical resources are already available and accessible.
Regional networks can be connected into a global network. Sharing information creates a connection that leads to mutual support and empowerment, for example the development of multi-centric research opportunities. There are many potential friends hidden by traditional communication barriers and institutional, economic, social, cultural and political restraints."
It is our hope that those who attended the conference and those who did not will use ProCOR, AMICOR, and other electronic networks as a way to continue and expand the conversation, introduce new topics, challenge one another, stay connected, and continue the global dialogue until we have achieved our goals.
Editor in Chief, ProCOR
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